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General NPI Number Information
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NPI Number | 1992732630
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Entity Type | Individual
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Provider Name | CHRIS O COSTAS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 02/16/2021
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Provider Practice Location Address
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Address Line | 6500 N CLARK ST
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City | CHICAGO
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State | IL
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Zip | 60626-4097
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Country | US
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Telephone | 847-866-6338
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Fax | 847-491-1392
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Provider Business Mailing Address
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Address Line | 546 W WELLINGTON AVE APT 2W
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City | CHICAGO
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State | IL
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Zip | 60657-0497
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Country | US
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Telephone | 773-671-1503
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 03666073
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 036067703
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License Number State | IL
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